DAMIEN JON ELLENS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056814

License Status

CANCELLED

Business

Title

First Name

DAMIEN

Middle

JON

Last Name

ELLENS

Business Name

DAMIEN JON ELLENS MD

Original Issue Date

06/23/2009

Effective Date

06/23/2009

Expiration Date

06/22/2012

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Neurological Surgery

Ever Disciplined

LastModifiedDate

07/07/2009